Community Care Customer Service Liaison

Salary: $58,193.00 to $92,541.00 Per Year

The Community Care Customer Service Liaison at the Michael E. DeBakey VA Medical Center will serve as the customer service specialist in the areas of Veteran inquiry resolution, consult and referral coordination, billing, claims, and administration of the Mission Act and Community Care programs.

Major duties

The Community Care Customer Service Liaison serves as the primary point of contact for Veterans, caregivers, and community providers regarding Community Care services, referrals, and benefits administration. Major duties include, but are not limited to: Serves as a liaison between Veterans, VA clinical and administrative staff, and community care providers to resolve inquiries, complaints, and concerns regarding access to care, referrals, authorizations, billing, and care coordination. Responds to and resolves inquiries received through multiple channels, including congressional correspondence, OIG, White House Hotline (WHH) cases, Patient Advocate Tracking System (PATS-R) entries, secure messages, and direct phone and email inquiries, ensuring all responses meet established suspense deadlines and documentation standards. Reviews and interprets Veterans Health Administration (VHA) policy, community care regulations, and eligibility criteria to accurately address Veteran concerns and determine appropriate resolution paths. Conducts chart reviews and coordinates with internal clinical staff, Patient Advocacy, and external community providers to research and resolve complex cases involving referral status, authorization denials, billing disputes, and care coordination delays. Communicates clearly and professionally, both orally and in writing, with Veterans, caregivers, community providers, and VA staff, including addressing sensitive or emotionally charged situations with professionalism, empathy, and de-escalation techniques. Documents all Veteran interactions accurately and thoroughly in applicable systems of record, ensuring case notes meet documentation standards required for audit, quality review, and leadership reporting purposes. Escalates complex, high-risk, or unresolved concerns to appropriate internal offices (e.g., Patient Advocacy, Clinical Leadership) or external partners (e.g., TriWest, VA Community Care Network administrators) for further investigation, quality review, and corrective action. Effectively navigate various data bases to ensure appropriate service recovery. (ECAMs, TriWest Portal, CPRS, CRM, JLV) Educates Veterans and caregivers on Community Care program requirements, referral and authorization processes, and available resources, including the National Community Care Contact Center (C4), My HealtheVet, and the VA Release of Information (ROI) office. Monitors the status of open referrals, authorizations, and consults to proactively identify potential lapses in care and coordinates with Primary Care and Community Care staff to prevent avoidable delays or disruptions in Veteran care. Prepares accurate, detailed written reports, summaries, and correspondence for use by supervisory staff, Patient Advocacy, and senior leadership in response to inquiries and quality reviews. Maintains current knowledge of applicable laws, regulations, and VHA policy, including the Integrated Veteran Care (IVC) Field Guidebook, to ensure consistent and compliant service delivery. Ensures compliance with the Community Care Field Guidebook, applying national and local guidance to care coordination, referral management, and Veteran communication activities. Performs other related duties as assigned in support of the Office of Integrated Veteran Care's mission to ensure Veterans receive timely, high-quality, coordinated care. Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule: Monday - Friday, 8:00am - 4:30pm; subject to change based on facility need. Virtual: This is not a virtual position. Position Description/PD#: Community Care Customer Service Liaison/PD03959A and PD03960A Relocation/Recruitment Incentives: Not Authorized. Critical Skills Incentive (CSI): Not Approved. Permanent Change of Station (PCS): Not Authorized.

Qualifications

Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-07 position you must have served 52 weeks at the GS-05. For a GS-09 position you must have served 52 weeks at the GS-07. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. Education and Experience Requirement: In addition to meeting the above Time-In-Grade requirement, applicants must also meet the experience and/or directly related education relevant to this position. You may qualify based on your experience and/or education as described belowYou may qualify based on your experience and/or education as described below: GS-07: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-05 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Communicating orally and in writing with Veterans, providers, and staff to resolve routine inquiries. Responding to inquiries regarding healthcare eligibility, referrals, and community care services under supervisory guidance Preparing oral and written reports and correspondence following established formats and procedures. Providing presentations to internal staff or stakeholder groups on standard program information. Reviewing and applying laws, regulations, policies, and standards relevant to Veterans healthcare eligibility and community care service delivery. Experience processing and resolving routine healthcare authorizations, claims, and billing inquiries. OR, Education Substitution (Transcripts required): Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have: Successfully completed one full year of graduate level education in a field related to this position that demonstrates the knowledge, skills, and abilities necessary to do the work of this position (i.e. hospital administration, public health administration, or related fields such as course work in health care administration). OR, Superior Academic Achievement (SAA): Completed all the requirements for a bachelor's degree in a curriculum that is qualifying (i.e. hospital administration, public health administration, or related fields such as course work in health care administration) for the position to be filled and I meet one of the following: Rank in the upper one-third of your class in the college, university or major subdivision; A grade-point average of "B" (a GPA of 2.95 or higher out of a possible 4.0) for all completed undergraduate courses, or those completed in the last two years of undergraduate study; A grade point average of "B+" (a GPA of 3.45 or higher out of a possible 4.0) for all courses in your major field of study, or those courses in your major completed in the last two years of undergraduate study; Membership in a National Honor Society (other than freshman honor societies) recognized by the Association of College Honor Societies. For a list of recognized honor societies please visit http://www.achsnatl.org/quick_link.asp. OR, Combination of Specialized Experience and Education (Transcripts required): Equivalent combination of successfully completed graduate education and specialized experience as described above to meet the total requirements. The education portion must include graduate courses that demonstrates the knowledge, skills, and abilities necessary to do the work of the position. Only education beyond a bachelor's degree may be used to qualify for the GS-07 level. This education must have been obtained in an accredited college or university. GS-09: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Independently communicating orally and in writing with Veterans, providers, congressional staff, and senior leadership to resolve complex or sensitive inquiries. Advising and providing guidance to Veterans, providers, and colleagues on the interpretation and application of healthcare eligibility and community care policy. Independently researching, interpreting, and applying laws, regulations, and policy to resolve complex, ambiguous, or precedent-setting eligibility and service delivery issues. Preparing detailed, analytically sound oral and written reports and correspondence for use by leadership, congressional offices, or oversight entities. Providing presentations and training to staff or partner agencies on program requirements, policy updates, or procedural changes. Reviewing laws, regulations, policies and standards as it relates to Veterans healthcare eligibility and other issues relevant to the delivery of government services. Experience independently resolving complex healthcare authorization, claims, and billing disputes involving multiple parties (e.g., VA, TriWest, community providers, insurance carriers). OR, Education Substitution (Transcripts required): Successfully completed a Master's or equivalent, or 2 years of progressively higher level education leading to such a degree, or an LL.B or J.D.in a field related to this position that demonstrates the knowledge, skills, and abilities necessary to do the work of this position (i.e. hospital administration, public health administration, or related fields such as course work in health care administration). OR, Combination of Specialized Experience and Education (Transcripts required): Equivalent combination of successfully completed graduate education and specialized experience (beyond the first graduate year or 18 semester hours) and specialized experience to meet the total experience requirements. The education portion must include graduate courses that demonstrates the knowledge, skills, and abilities necessary to do the work of the position. Physical Requirements: Work is mostly sedentary; however, standing during presentations or training, bending, and carrying light items is required. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.